chpt 11 Flashcards
Persistent enlargement in the submandibular gland
Kuttner’s tumor
All ages
Fluctuant to firm
Lower lip 60%
Superficial form post. BM
Mucocele
Epithelial lined cavity
May represent duct obstruction
Adults; major glands parotid; minor glands FOM, BM and lips
Salivary duct cyst
Mucocele or mucus cyst - treatment
Remove surgically with adjacent glands
mucocele, floor of the mouth
Raises tongue
Worries patient
May rupture
Ranula
Mucous escape reaction in FOM
Plunging ranula when spilled mucin dissects mylohyoid
ranula
treatment for ranula
removal of feeding sublingual gland and/or marsupialization
salivary stone symptoms
2 days duration
On/off swelling
Progressive pain
Worse at mealtime
Temperature at examinatio
Most often ductal system of submandibular gland
Major gland sialoliths cause episodic swelling especially at mealtime
Salivary gland endoscopy and lithotripsy
sialolithiasis
Sialagogues, moist heat and increased fluid intake may promote passage of stone
Minor gland involvement surgical removal; sometimes may need to remove major gland
sialolithiasis
Infectious and non-inf. causes
Mumps and surgical mumps (NPO and atropine)
Staphlococcus aureus; acute bacterial sialadenitis (ABS)
Non-infectious; Sjogren Syn. sarcoidosis, radiation therapy and various allergens
Sialadenitis
Acute bacterial sialadenitis most common parotid; bilateral 10-25%
Affected gland swollen, painful and overlying skin erythematous
Low-grade fever, possibly trismis and purulent discharge from duct orifice
sialadenitis
Sialography sialectasia proximal to obstruction
In submand. G. persistent enlargement (Kuttner tumor)
Subacute necrotizing S. involves minor glands of hard and soft palate represents painful intact nodule
Sialadenitis
involves minor glands of hard and soft palate represents painful intact nodule
subacute necrotizing sialadenitis
3 subtypes of cheilitis glandularis
- Simple
- Superficial suppurative → BAELZ’S disease
- Deep suppurative → Cheilitis glandularis apostematosa
- Rare inflammatory condition of minor salivary glands
- Lower lip with swelling and eversion as a result of hypertrophy and inflammation of the glands. The openings of minor salivary ducts are inflamed and dilated and pressure on the glands may produce mucopurulent secretions from the ductal openings
- Affects middle aged and older MEN
cheilitis glandularis
•Tx of persistent cheilitis glandularis with actinic damage
VERMILLIONECTOMY
what is the danger of cheilitis glandularis?
o 18-35% of cases are associated with SCC due to actinic change
• excessive salivation
Sialorrhea
- location irritations such as apthuous ulcers and new dentures
- GERD
- Heavy metals and rabies
- Medications: lithium and cholinergic agonists
Causes of Sialorrhea
o Episodes of excessive salivation lasting 2-5 minutes
o Episodes are associated with a prodrome of nausea or epigastric pain
idiopathic paroxysmal siallorhea
o Anticholinergic medications
o Transdermal scopolamine (use in ppl > 10 yrs)
o Surgery if the problem is neuromuscular
o Control GERD if this is a factor
treatment for sialorrhea
• Drooling problem in pts who are mentally retarded, have a neuromuscular disorder like cerebral palsy (cp) or who have had surgical resection of the mandible; NOT due to overproduction of saliva but due to poor neuromuscular control
sialloehea
Treatment of acute sialadenitis
Antibiotics and rehydration
How differentiate sialadenitis from salivary gland tumor
Sialdenitis will have pain
First, Second, and Third leading cause of Xerostomia
DRUGS
What’s the anti rule for xerostomia
if it’s an anti drug (e.g. antidepressant) it causes xerostomia
Treatments for Xerostomia
Biotene
Prevident 5000
Pilocarpine 5 mg tabs
What infection is seen with Xerostomia
candidiasis
Cervical and root caries
This is a cause of Xerostomia that is normally a unilateral swelling of the parotid gland
Benign lymphoepithelial lesion
What is the characteristic histo associated with Benign Lymphepithelial Lesion
epimyoepithelial islands
Symptoms associated with Sjogren syndrome or any xerostomia
red tender oral mucosa
Angular cheilitis
Candidiasis
Cervical Decay
Difficulty swallowing
Altered taste
Retrograde bacterial sialadenitis
Fruit laden branchless tree
Sialographic look or Sjogren syndrome
tear test for Sjogren Syndrome
Schirmer test (<5mm tears for 5 min = Keratoconjuctivitis sicca)
NON INFLAMMATORY disorder characterized by salivary gland enlargement, especially parotid, usually do to some underlying systemic problem
Sialadenosis/Sialosis
Systemic conditions associated with Sialadenosis
Diabetes melitis Malnutrition
Alcoholism
Bulimia
Locally destructive inflammatory condition of salivary glands caused by ischemia that leads to local infarction. The problem is it mimics a malignant process clinically and microscopically
Necrotizing Sialometaplasia
What is one way to differentiate Necrotizing Sialometaplasia from Oral Cancer
Cleaner borders around the lesion (cancer has ragged borders)
Where is Necrotizing Sialometaplasia commonly found
Posterior Palate salivary glands (squamous cell carcinoma rare on palate)
Treatment for Necrotizing Sialometaplasia
Biopsy and no treatment, will resolve in 5-6 weeks
